Brain Injury Medicine: Principles and Practice. Nathan Zasler, Douglas Katz, and Ross Zafonte, eds, New York: Demos Publishing Company, 2007. 1275 pages, hardcover, ISBN-13: 978-1888799-93-4, ISBN-10: 1-888799-93-5.

Brain Injury Medicine: Principles and Practice is a comprehensive reference for clinicians caring for individuals who have sustained a traumatic brain injury (TBI). In general, the text is engaging, relatively easy to read, and, most importantly, current with respect to topics that are pertinent to the contemporary practitioner. This book attempts to organize an enormous amount of information in a practical, easy-to-use format. With any project of this size and scope, there will always be criticisms of how the information is presented, and the particulars of what was included and excluded. However, all in all, the editors did an extraordinary job in completing this task.

The volume is generally well organized from front to back, beginning with an overview of the evolution of the practice of TBI rehabilitation medicine, from national, international, and historical perspectives, including an overview of the unique challenges faced by individuals attempting to research various aspects of TBI. The book progresses through sections on current population-based epidemiological information, concepts of pathophysiology and theories of recovery, and neurodiagnostics, before tackling the "nuts and bolts" of various medical issues and complications experienced by TBI patients. These middle chapters, whose information is organized by organ systems, are likely to provide the main value to clinicians. The book then progresses through discussions of special populations, including an interesting discussion of the controversy surrounding treatment of patients with mild TBI, and then moves on through several chapters focused on therapy interventions, such as cognitive rehabilitation, speech and language therapy, physical therapy, and occupational therapy. The chapter on alternative medicine interventions is excellent, with references on current evidence (or lack thereof) for many alternative medicine approaches. The book concludes with chapters on medicolegal and ethical issues.

There are several areas where minor improvements in the organization could be made. There are a few instances where concepts are combined into 1 chapter, though each deserves a chapter of its own. A good example is chapter 37, "Sexuality, reproduction, and neuroendocrine dysfunction," which could have been divided into separate chapters on "Endocrine dysfunction" and "Sexuality and reproduction." Additionally, the last section of the book focused more on the medicolegal aspects of brain injury care and less on the true ethical issues faced by the TBI clinician. Some chapters tended to get bogged down in the explanation of complex information, such as the chapters on pathobiology and neuroimaging. In some cases, information was presented without accompanying diagrams, or figures were not placed next to the adjacent text, requiring the reader to flip back and forth between diagram and text, making the text more difficult to interpret than necessary. However, these chapters were comprehensive in their presentation of the material.

A glaring omission is failure to provide a discussion about blast injuries, which is certain to be an issue faced by many in the field with veterans returning from military theaters in Iraq and Afghanistan. Indeed, "blast injury" is not even listed in the index. A related topic, the "Second impact syndrome," was approached in a somewhat cavalier manner in this book, particularly in light of the deaths that have occurred as a result of this phenomenon. A text of this size should also include a discussion of differences in treatment paradigms within civilian and veteran's administration systems, particularly given the current political climate regarding TBI and the discussions about how returning veterans are to be served.

One other suggestion for future editions would be to include some information in easily accessed tables, either in an appendix or printed inside the front or back cover. This device, used in other textbooks, would make the book more useful to the clinician or student. Suggestions for tables would include quick references for the Glasgow Coma Scale, the Rancho Los Amigos Stages of Recovery, concussion guideline tables, Glasgow Outcome Scale, and others.

This book is a welcome addition to the literature on TBI. The middle section, where clinical issues are presented by organ system, have the most valuable chapters of the book. Although not without criticism, information presented is balanced, evidence based, and thorough, and criticisms are minor. This volume takes many of the controversial topics in TBI and presents objective discussions of the issues. In summary, this text is a necessary addition to the reference libraries of clinicians caring for individuals with TBI and should be a required text for fellows completing their training.

David L. Ripley, MD, MS

Kristine Pacheco, MMS, PA-C

Craig Hospital, Englewood, Colo